Human pituitary disease.

Fraser, Russell

doi:10.1136/bmj.4.5733.449

Cited by 10 publications

(6 citation statements)

References 39 publications

(19 reference statements)

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“…Our results confirm earlier reports on the prevalence of pituitary dysfunction in patients with pituitary disease (Brasel et al, 1965;Rabkin & Frantz, 1966;Fraser, 1970;Lindholm el al., 1976). Decreased growth hormone secretion was the most frequent C. Hagen at al.…”

Section: Discussionsupporting

confidence: 93%

Relationship Between Plasma Prolactin Concentration and Pituitary Function in Patients With a Pituitary Adenoma

Hagen

Lindholm

Suenson

et al. 1979

Clinical Endocrinology

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The influence of hyperprolactinaemia on endocrine functions in forty-two consecutive patients with untreated pituitary tumours was studied. Patients with acromegaly, Cushing's disease and Nelson's syndrome were excluded. Sixteen patients (eleven men and five women) had a pituitary adenoma with suprasellar extension and twenty-six (eleven men and fifteen women) had a small intrasellar tumour. Basal plasma prolactin concentration was measured in all. Thyroid function was assessed by plasma thyroxine (T4) and TSH concentrations, adrenocortical function and growth hormone (GH) secretion by the maximum plasma cortisol, adrenocorticotrophin (ACTH) and GH concentrations, respectively, during insulin-induced hypoglycaemia (tITT). Gonadal function was studied by measuring plasma concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestradiol-17 beta and in men, testosterone. On the basis of computer assisted tomography of the sella turcica, the tumour volume was calculated. The basal plasma prolactin concentration was elevated in 69% of the patients. Decreased GH secretion was the most frequent pituitary dysfunction (78%) followed in men by gonadal insufficiency (77%), adrenocortical insufficiency (31%) and thyroid insufficiency (21%). There was no difference between patients with elevated and normal plasma prolactin concentration as to the tumour volume and any of the endocrine variables.

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Section: Discussionsupporting

confidence: 93%

Relationship Between Plasma Prolactin Concentration and Pituitary Function in Patients With a Pituitary Adenoma

Hagen

Lindholm

Suenson

et al. 1979

Clinical Endocrinology

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“…These findings agree with previous observations of GH deficiency as the most common outcome after pituitary destruction (12)(13)(14). A possible causal relationship between GH and development of diabetic retinopathy has been suggested (151, based on the observation of an abnormal GH response to exercise in young diabetics in combination with the experiences from surgical ablation of the pituitary in severe retinopathy.…”

Section: Discussionsupporting

confidence: 90%

Long‐term Insulin‐dependent Diabetes Mellitus with Secondary Pituitary Insufficiency and Regression of Retinopathy

Bliddal

Thorsteinsson

Munkgaard

1983

Journal of Internal Medicine

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and m~a MU~KGAARD ABSTRACT. Btiddal H, Thorsteinsson B, Munkgaard S. (Medical Departments E and B, Frederiksberg Hospital, Copenhagen, Denmark.) Long-term insulin-dependent diabetes mellitus with secondary pituitary insufficiency and regression of retinopathy. Acta Med Three women with insulin-dependent diabetes mellitus (IDDM) from childhood and early development of diabetic retidopathy are described. Insulin requirement was reduced to 5-12 IU daily in all three after relatively uncomplicated births and all had very brittle diabetes on this dosage. At re-examination 1622 years after these births and after 34-42 years of IDDM, regression of retinopathy was observed in two patients, while the third had a light retinopathy at the same level as initially. Other diabetic complications were few and none of the patients had nephropathy. Pituitary examination revealed incomplete hypopituitarism in all cases, human growth hormone (HGH) being the sole common factor lacking. These findings and a review of four similar cases reported previously lend some support to the hypothesis of HGH as a possible pathogenetic co-determinant in the development of diabetic retinopathy. Key words: diabetes mellitus, insulin, C-peptide, hypopituitarism, growth hormone, retinopathy. Sc-d 1983; 214: 225-9. The occurrence of spontaneous hypopituitarism in patients with insulin-dependent diabetes mellitus (IDDM) (the Houssay phenomenon) is well documented (1-3). However, only few cases with a sufficient period of observation after the onset of hypopituitarism and detailed examination of the pituitary function have been reported (4-8). Furthermore, late diabetic complications have only rarely been observed before the development of hypopituitarism, thus making observations of changes in the extent of these complications possible (4, 5, 8-10).This study describes three patients with long-term IDDM who developed partial pituitary insufficiency presumably due to Sheehan's syndrome, with emphasis on the investigation of the pituitary function, basal as well as stimulated, and the late diabetic complications. PATIENTS AND METHODS Hormone analysesSerum thyroxine (T4), triiodothyronine and thyrotropin (TSH) were measured by routine radioimmunoassay in our laboratory. Follicular stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH) and prolactin (PRL) in serum were measured by radioimmunoassay. 17-Hydroxycorticoids (17-OHC), cortisol and 11-deoxy-cortisol in serum and urine were estimated by photometry in a commercial laboratory (Medicinsk Laboratorium, Copenhagen).Abbreviations: T4 = thyroxine, TSH = thyrotropin, TRH = TSH releasing hormone, FSH = follicular stimulating hormone, LH = luteinizing hormone, LHRH = LH releasing hormone, GH = growth hormone, PRL = prolactin, 17-OHC = 17-hydroxycorticoids, ACTH = adrenocorticotropic hormone, IDDM = insulin-dependent diabetes mellitus. 15-838713

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“…ng/ml); 3 of these patients (nos. 1,2,4) In this patient, complete removal of the continued to have abnormal rise of hGH pituitary tumor by the transnasal trans-after TRH administration (Table 1). sphenoidal route was technically difficult Fasting serum PRL in the 12 controls because of fibrosis and adhesions to the studied was 2-20 ng/ml with a mean of diaphragma sella as a result of previous 12.5 ± SD 6 and the maximum level after surgery.…”

Section: Resultsmentioning

confidence: 90%

“…(/ Clin Endocrinol Metab 38: 957,1974) V ARIOUS stimulation tests for growth hormone (hGH) reserve in normal subjects have been appraised. The best available tests seem to be an intravenous insulin tolerance (ITT) and intravenous arginine tests (1,2,3). Recently, an increase in serum hGH concentration in a majority of patients with active acromegaly but not in normal subjects has been observed after thyrotropin-releasing hormone (TRH) injection (4,5,6,7).…”

mentioning

confidence: 98%

Serum Growth Hormone and Prolactin Response to Thyrotropin-Releasing Hormone in Patients with Acromegaly Before and After Surgery

Samaan

Leavens

Jesse

1974

The Journal of Clinical Endocrinology & Metabolism

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The immunoreactive serum human growth hormone (hGH), prolactin (PRL), and thyroid-stimulating hormone (TSH) concentrations were measured after administration of 500 fig of thyrotropin-releasing hormone (TRH) intravenously (iv) in 8 patients with acromegaly before and after transnasal transsphenoidal microdissection hypophysectomy and 3 patients after transfrontal hypophysectomy. Other pituitary function tests were also assessed. The hGH, PRL, and TSH responses to TRH administration in these patients were compared to those found in 12 normal subjects of the same age range and sex. The hGH response to TRH in these patients was compared to that found after intravenous insulin tolerance (ITT), arginine infusion and oral glucose tolerance (GTT) tests.The serum hGH concentration rose significantly in all the acromegalic patients after TRH administration before therapy, while no rise was seen in normals. In the majority of patients studied, the rise of hGH level after ITT, iv arginine and oral GTT was not as high or as frequent. After therapy, some of the patients who had basal serum hGH levels within normal range (less than 10 ng/ml) continued to have abnormal rise in hGH after TRH administration.Serum PRL levels rose in all acromegalic patients after TRH administration and fell significantly after treatment. Three acromegalics had abnormally high serum PRL levels at basal and during TRH administration.TSH response to TRH was within the low normal range in the majority of patients studied before therapy. Ten of the 11 patients studied after hypophysectomy showed diminished TSH reserve but only 7 showed signs of hypothyroidism by other criteria.These results indicate: 1) High serum hGH levels at basal and TRH stimulation may aid in establishing the diagnosis of acromegaly. 2) High hGH in acromegalic patients after TRH administration may persist after therapy in spite of a normal basal hGH level. 3) TRH stimulation in acromegalics before and after therapy may show the hGH, PRL, and TSH pituitary reserve. (/ Clin Endocrinol Metab 38: 957, 1974)

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Human pituitary disease.

Cited by 10 publications

References 39 publications

Relationship Between Plasma Prolactin Concentration and Pituitary Function in Patients With a Pituitary Adenoma

Relationship Between Plasma Prolactin Concentration and Pituitary Function in Patients With a Pituitary Adenoma

Long‐term Insulin‐dependent Diabetes Mellitus with Secondary Pituitary Insufficiency and Regression of Retinopathy

Serum Growth Hormone and Prolactin Response to Thyrotropin-Releasing Hormone in Patients with Acromegaly Before and After Surgery

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